0-9 Month - Child Developmental Evaluation

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Denver prescreening Developmental evaluation Adoptive parents can perform a simple Denver prescreening Developmental
evaluation while visiting the child in the orphanage. This information can be vital during the
pre-adoption evaluation. Continue to answer until 3 NO's are circled

1) Equal Movements:	Office Use	Comments	Yes	No
When your baby is lying on his back, can he move each of his arms easily as the other and each of his legs easily as the other? Circle NO if your baby makes jerky or uncoordinated movements with one or both of his arms or legs.	Gross Motor Tone 90%: 0 mo 75%: 0 mo

2) Response to Sounds	Office Use	Comments	Yes	No
Does your baby respond (with eye movements, changes in breathing, or other changes in activity) to a new sound outside his line of vision?	Language 90%: 0 mo 75%: 0 mo
3) Regards Face	Office Use	Comments	Yes	No
When your baby is lying on her back, does she look at you and watch your face?	Psycho-Social 90%: 0 mo 75%: 0 mo
4) Vocalizes	Office Use	Comments	Yes	No
Does your baby make sounds other than crying, such as uh, eh or cooing?	Language 90%: 0-3 mo. 75%: 0 months
5) Smiles Responsively	Office Use	Comments	Yes	No
When you smile and talk to your baby, does he smile back at you?	Psycho-social 90%: 1-2 mo. 75%: 1 months
6) Head up to 45 Degrees	Office Use	Comments	Yes	No
When your baby is on her stomach on a flat surface, can she lift her head to 45 degree angle?	Gross Motor 90%: 2-3mo. 75%: 1-3 mo.
7) "Ooo" and "Aaa"	Office Use	Comments	Yes	No
Does your baby make vowel sounds such as "Ooo" or "Aaa" ?	Language 90%: 2-3mo. 75%: 1-3 mo.
8) Head up to 90 degrees	Office Use	Comments	Yes	No
When your baby is on her stomach on a flat surface, can she lift her head and chest to 90 degree angle and look straight ahead?	Gross Motor 90%: 3-2 mo 75%: 2-3 mo.
9) Hands together	Office Use	Comments	Yes	No
Does your baby play with his hands by touching them together?	Fine motor 90%: 4 mo 75%: 2-3 mo
10) Regards own Hand	Office Use	Comments	Yes	No
Have you seen your baby stare at his own hands for at least 5 seconds?	Psycho-social 90%: 4 mo 75%: 3 mo
11) Squeals	Office Use	Comments	Yes	No
Does your baby make happy, excited, high pitched squealing sounds which are not crying?	Language 90%: 4-1 mo. 75%: 2-3 mo
12) Bears weight on legs?	Office Use	Comments	Yes	No
When you stand your baby up, holding her under the arms, does she try to stand on her feet and support some of her own weight?	Gross motor 90%: 4-1 mo. 75%: 3-2 mo
13) Follows 180 degrees?	Office Use	Comments	Yes	No
While the baby is on his back, move your hand from side to side above his face. Did your baby watch your hand by turning his head from one side all the way to the other side?	90%: 4-2 mo. 75%: 3-3 mo.
14) Chest Up-Arm Support	Office Use	Comments	Yes	No
When your child is on her stomach on a flat surface, can she lift her chest using her arms to hold herself up?	Gross Motor 90%: 4-2mo 75%: 4 mo
15) Regards Small Objects	Office Use	Comments	Yes	No
Can your baby focus her eyes on a small object the size of a pea or a penny?	Fine Motor 90%: 5 Mo 75%: 4-1 mo
16) Rolls Over	Office Use	Comments	Yes	No
Has your baby rolled over at least 2 times, from stomach to back and from back to stomach?	Gross motor 90%: 5-1 mo 75%: 4-1mo
17) Turns to sound	Office Use	Comments	Yes	No
Does your baby turn his head towards a soft sound, when the source of the sound is out of sight?	Language 90%: 5-2 mo 75%: 4-3 mo
18) Reaches	Office Use	Comments	Yes	No
Can your baby pick up a toy if placed within reach?	Fine motor 90%: 5-2 mo 75%: 5 mo
19) Works for toy	Office Use	Comments	Yes	No
When your child wants something that is out of reach, does your baby try to get it by stretching his arms or body?	Pycho-social 90%: 5-3 mo 75%: 5-1 mo
20) Feeds self	Office Use	Comments	Yes	No
Can your baby feed herself a cracker or cookie? If she has never been given one , circle no!	Pycho-social 90%: 6-2 mo 75%: 5-3 mo
21) Turns to voice	Office Use	Comments	Yes	No
When your baby is playing and you come up quietly behind him, does your baby turn his head as though he heard you?	Language 90%: 6-2 mo 75%: 5-2 mo
22) Sits, No support	Office Use	Comments	Yes	No
Without being propped by pillows or a chair, or a wall, can your baby sit by herself for at least 10 seconds?	Gross motor 90%: 6-3 mo 75%: 6-1 mo
23) Looks for Yarn	Office Use	Comments	Yes	No
Please follow directions. Hold a tissue or soft object up high, wave it or shake it. When your baby is looking at it, drop it to the floor. Did your baby look down to she where it went?	Fine motor 90%: 7 mo 75%: 6-2 mo
24) Rakes Raisin	Office Use	Comments	Yes	No
Can your baby pick up tiny objects, such as a raisin or piece of food with either his whole hand using a raking or grabbing motion, or with his thumb and fingers?	Fine motor 90%: 7-1 mo 75%: 6-2 mo
25) Single syllables	Office Use	Comments	Yes	No
Does your baby make sounds that have both consonants and vowels as "Da" "ba" "ga" "ma"?	Language 90%: 7-2 mo 75%: 6-2 mo
26) Stands holding on	Office Use	Comments	Yes	No
Can your baby stand holding on to a chair or a table for 10 seconds or more?	Gross motor 90%: 8-2 mo 75%: 7-3 mo
27) Imitates sound or speech	Office Use	Comments	Yes	No
Does your baby ever copy you when you make some speech sounds like, kissing, coughing, or saying a word?	Language 90%: 8-3 mo 75%: 6 mo

For Office use:Toady's Date: ______yr_____mo_____day
Child's Birthday:_______yr_____mo_____day
Subtract to get
Child's Exact age:______yr_____mo_____day
PDQII Age: ______yr_____mo_____day

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